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This Week in JAMA
October 8, 2008

This Week in JAMA

JAMA. 2008;300(14):1621. doi:10.1001/jama.300.14.1621

Patients with suspected deep vein thrombosis (DVT) of the lower extremities may be evaluated with either proximal vein 2-point ultrasonography or whole-leg ultrasonography. To assess whether the 2 strategies are equivalent, Bernardi and colleagues Article randomly assigned 2098 consecutive outpatients with symptoms of a first-episode lower-extremity DVT to undergo either 2-point ultrasonography (plus D-dimer testing) or whole-leg color-coded Doppler ultrasonography. Patients with normal findings were followed up for 3 months. The authors report the 2 diagnostic strategies were equivalent for the detection of symptomatic venous thromboembolism. In an editorial, Landefeld Article discusses the diagnosis of DVT.

Pharmacological treatment of benign prostatic hyperplasia includes 5-α reductase inhibitors (eg, finasteride), which block the conversion of testosterone to dihydrotestosterone. Whether 5-α reductase inhibitors adversely affect bone health is not clear. In a case-control study involving patients with a diagnosis of benign prostatic hyperplasia, Jacobsen and colleagues assessed the association between use of 5-α reductase inhibitors and incident hip fracture. The authors found no association of exposure to 5-α reductase inhibitors with increased risk of hip fracture.

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Patients and physicians are encouraged to engage in conversations about end-of-life goals and expectations for medical care. However, it is not known whether these discussions are associated with less aggressive care or with increased or decreased patient and caregiver psychological distress. Wright and colleagues analyzed data from a multisite prospective cohort study of 332 patients with advanced cancer and their informal caregivers. The authors found that end-of-life discussions with physicians were associated with less aggressive medical care in the final week of life and earlier referrals to hospice. End-of-life discussions were not associated with more worry or higher rates of depression among patients, nor were they associated with worse bereavement adjustment among caregivers.

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Data suggest that male circumcision reduces men's risk of contracting human immunodeficiency virus (HIV) during heterosexual intercourse. Whether circumcision is associated with reduced risks of HIV infection among men who have sex with men is not certain. Millett and colleagues Article pooled data from 15 observational studies that involved 53 567 men who have sex with men to assess the association between male circumcision and HIV and other sexually transmitted infections (STIs). The authors conclude there is insufficient evidence that male circumcision protects against HIV or other STIs among men who have sex with men. In an editorial, Vermund and Qian Article discuss the implications of this finding for future research and HIV risk-reduction strategies.

Mr E, a 56-year-old man with severe chronic obstructive pulmonary disease, had acute renal and respiratory failure that resulted in a 2-month medical intensive care unit stay complicated by aspiration, sepsis, and significant weight loss. Needham discusses the evidence supporting the safety, feasibility, and potential benefits of early mobilization of patients receiving mechanical ventilation.

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“Surgeons often have to judge the benefits of waiting, to prepare a patient for an operation . . . but not in this case.” From “Saturday.”

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Some scientists say information provided by genome-wide prenatal tests is often ambiguous and may confuse parents.

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Patient care, square-rigger sailing, and safety

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Disclosing genetic research results after pediatric deaths

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Join Ingrid Nygaard, MD, MS, October 15 from 2 to 3 pm eastern time to discuss symptomatic pelvic floor disorders in women. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl

How would you manage an 82-year-old woman with hypertension and renal artery stenosis? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is October 29.

For your patients: Information about thrombophlebitis.

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